Tackling Obesity in England - National Audit Office

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TACKLING OBESITY IN ENGLAND31 While the approach used may, for the above reasons,overestimate the indirect costs of obesity to theeconomy, the analysis nevertheless serves todemonstrate the substantial burden of obesity toindividuals in terms of sickness and mortality.Conclusion32 The direct cost of obesity to the National Health Servicein England in 1998 was at least £480 million, equivalentto about 1.5 per cent of NHS expenditure in that year.The direct cost is driven primarily by the costs of treatingthe secondary diseases attributable to obesity, whichaccounted for 98 per cent of the total. The mostsignificant cost drivers by far are hypertension, coronaryheart disease, and Type 2 diabetes, followed byosteoarthritis and stroke.33 Direct costs are probably under-estimated by thisanalysis due to the factors outlined in the discussionabove, in particular the potentially high costs associatedwith treating obesity-related depression and hyperlipidemia.It also excludes other public expenditure notborne directly by the National Health Service, such asthe costs of social care for obesity-related strokepatients.36Total cost of obesity in England in 1998Cost componentCost (£m)Cost of treating obesityGeneral Practitioner consultations 6.8Ordinary admissions 1.3Day cases 0.1Outpatient attendances 0.5Prescriptions 0.8Total costs of treating obesity 9.5Cost of treating the consequences of obesityGeneral Practitioner consultations 44.9Ordinary admissions 120.7Day cases 5.2Outpatient attendances 51.9Prescriptions 247.2Total costs of treating the consequences of obesity 469.9Total direct costs 479.4Indirect costsLost earnings due to attributable mortality 827.8Lost earnings due to attributable sickness 1,321.7Total indirect costs 2,149.5Grand total 2,628.934 The indirect cost of obesity in England in 1998represented by lost earnings was estimated to be£2,149 million, of which 61 per cent was due tosickness absence attributable to obesity, and theremainder to premature mortality. The amount ofsickness absence due to obesity may be under-estimateddue to the exclusion of back pain, a potentiallysignificant contributor. A friction cost approach tovaluing lost output would reduce the estimates,however.35 Combining our best estimates of direct and indirectcosts, the total cost of obesity in England in 1998 was£2.6 billion, or 0.3 per cent of UK Gross DomesticProduct. Direct costs accounted for 18 per cent of thetotal. The full results are summarised in Figure 36.appendix six61
TACKLING OBESITY IN ENGLANDStudies selected for baseline analysis (obtained fromsystematic literature review)abcdefghiManson JE, et al. A prospective study of obesity andrisk of coronary heart disease in women. N Engl J Med.1990 Mar 29;322(13):882-9.Reuterwall C, et al. Higher relative, but lower absoluterisks of myocardial infarction in women than in men:analysis of some major risk factors in the SHEEP study.The SHEEP Study Group. J Intern Med. 1999Aug;246(2):161-74.Tikly M, et al. Risk factors for gout: a hospital-basedstudy in urban black South Africans. Rev Rhum EnglEd. 1998 Apr;65(4):225-31.Shoff SM, et al. Diabetes, body size, and risk ofendometrial cancer. Am J Epidemiol. 1998Aug 1;148(3):234-40.Ford ES. Body mass index and colon cancer in anational sample of adult US men and women. Am JEpidemiol. 1999 Aug 15;150(4):390-8.Giovannucci E, et al. Physical activity, obesity, and riskof colorectal adenoma in women (United States).Cancer Causes Control. 1996 Mar;7(2):253-63.Farrow DC, et al. Association of obesity and ovariancancer in a case-control study. Am J Epidemiol. 1989Jun;129(6):1300-4.Andersson SO, et al. Body size and prostate cancer: a20-year follow-up study among 135006 Swedishconstruction workers. J Natl Cancer Inst. 1997Mar 5;89(5):385-9.Chan JM, et al. Obesity, fat distribution, and weightgain as risk factors for clinical diabetes in men.Diabetes Care. 1994 Sep;17(9):961-9.jklmCarey VJ, et al. Body fat distribution and risk of noninsulin-dependentdiabetes mellitus in women. TheNurses' Health Study. Am J Epidemiol. 1997Apr 1;145(7):614-9.Cooper C, et al. Individual risk factors for hiposteoarthritis: obesity, hip injury, and physical activity.Am J Epidemiol. 1998 Mar 15;147(6):516-22.Sahyoun NR, et al. Body mass index, weight change,and incidence of self-reported physician-diagnosedarthritis among women. Am J Public Health. 1999Mar;89(3):391-4.Kato I, et al. Prospective study of clinical gallbladderdisease and its association with obesity, physicalactivity, and other factors. Dig Dis Sci. 1992May;37(5):784-90.n Cairney J, et al. Correlates of body weight in the 1994National Population Health Survey. Int J Obes RelatMetab Disord. 1998 Jun;22(6):584-91.opqrHuang Z, et al. Body weight, weight change, and riskfor hypertension in women. Ann Intern Med. 1998Jan 15;128(2):81-8.Walker SP, et al. Body size and fat distribution aspredictors of stroke among US men. Am J Epidemiol.1996 Dec 15;144(12):1143-50.Rexrode KM, et al. A prospective study of body massindex, weight change, and risk of stroke in women.JAMA. 1997 May 21;277(19):1539-45.Calle EE, et al. Body-mass index and mortality in aprospective cohort of U.S. adults. N Engl J Med. 1999Oct 7;341(15):1097-105.appendix six62
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